Real-world treatment patterns, persistence, and discontinuation of finerenone in chronic kidney disease: a systematic review and meta-analysis of proportions

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Finerenone is increasingly used in routine care, but real-world evidence on initiation dose, titration, persistence, and discontinuation is fragmented and definitions vary. The observational reports of adults initiating finerenone in routine clinical practice were systematically reviewed and pooled proportions when the protocol-defined program threshold was met. PubMed, Europe PMC, Crossref, ClinicalTrials.gov, medRxiv/bioRxiv routes, and grey literature were searched to 28 July 2026, with a disclosed supplementary search on 2 August 2026. Two independent screening passes screened records and full texts, with human adjudication and source verification; extraction and risk-of-bias assessment used the prespecified methods. Of 265 screened records, 62 reports were assessed, and 17 reports representing 16 independent programs were included. Initiation at 10 mg pooled at 87.31% (95% confidence interval [CI] 72.08-94.82; 95% prediction interval [PI] 21.87-99.41; 11 programs). All-cause discontinuation pooled at 11.18% (95% CI 6.43-18.72; 95% PI 2.58-37.43; 7 programs); a companion integer-count model gave 9.96% (95% CI 5.49-17.38; 6 programs). Hyperkalemia-attributed discontinuation pooled exploratorily at 2.78% (95% CI 0.75-9.80; 95% PI 0.15-34.97; 5 programs). No study contributed a quantitative estimate at the registered 6-month up-titration anchor. Heterogeneity was extreme, and certainty of evidence was very low for all pooled estimates. The principal finding was the measurement dependence: pooled proportions do not describe a stable “typical” real-world pattern across settings.